Category: Medical

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Freed Russian Spy Likely Poisoned: What experts might be used in this investigation?

on March 6, 2018

Yesterday, news broke that a former Russian spy, Sergei Skripal, and his daughter, Yulia, were found unresponsive on a park bench in Salisbury, England. News reports revealed Mr. Skripal and his daughter were suffering from exposure to an “unknown substance.”

According to an article in the Daily Mail today, “Two police officers who were among the first to come into contact with Mr Skripal and his daughter on Sunday were also admitted to hospital after suffering itchy eyes, rashes and wheezing on Sunday. Up to 10 other people suffered symptoms including vomiting.” One member of emergency services remains in the hospital as of this writing. Mr. Skripal and his daughter are both in critical condition. The substance remains unknown.

Of course, this instance immediately reminded me of the 2006 poisoning of former Russian spy Alexander Litvinenko. Mr. Litvinenko’s tea was laced with a radioactive material known as polonium-210, causing sudden illness and hospitalization. He died approximately three weeks later. UK inquests have determined the Russian Federation was responsible for Litvinenko’s assassination.

From reading a bit about both of these matters, I begin to understand that Russia does not take kindly to turncoats. They are also very brazen in their efforts to eliminate enemies of the state.

Reading about the potential poisoning of Mr. Skripal got me thinking about the types of experts that would be used in the investigation and possible criminal or civil actions related to this assault.

HAZMAT & Emergency Services:

Images from multiple news stories show a HAZMAT response to decontaminate the area from exposure to the “unknown substance.” I am unfamiliar with different levels of hazardous material responses, but I imagine HAZMAT experts will be required to help investigators determine the type of substance based on their response. It appears the immediate area around the bench, first-responders, and a restaurant in Salisbury are all being decontaminated.

There is no evidence of a large-scale quarantine nor is an entire block cordoned off. So, it appears HAZMAT believes the chance for further exposure to the community is limited. Such a response likely eliminates the threat of certain chemical or biological contaminants which could result in greater danger to the community.

Nuclear, Chemical, and Biological:

The post from the Daily Mail tells us, “Tests on the substance involved are being carried out at the defence research centre at Porton Down.”

There must have been evidence of the substance available at the scene allowing for samples to be taken for testing. Based on the previous assassination of a former Russian spy using radioactive materials, one can conclude nuclear scientists will be vigorously investigating the substance for radioactivity.

Since Scotland Yard’s counter-terror investigators are involved, it is reasonable to assume chemists and biologists will also be conducting tests on the substance.

A Toxicology Investigation:

I know most of us in the legal community think of forensic toxicologists being needed to detect drugs in a person’s system. Usually we see the use of toxicologists in a DUI, employment, or toxic tort related matter.

We don’t normally think of the need for toxicologists in an assassination or attempted assassination. However, if we remove the international intrigue from the equation, we are simply left with murder or attempted murder. Therefore, investigators will need to know the impact of the substance on Mr. Skripal and his daughter.

The Daily Mail noted, ” Emergency services initially believed Mr. Skripal and his daughter had taken fentanyl, a synthetic opioid that is up to 100 times more potent than heroin that has caused thousands of deaths among drug addicts worldwide.”

A toxicological investigation of the Skripal’s will be necessary to help determine the substance used to either drug or poison them.

Conclusion:

It is too early to conclude anything. Until we know more about the substance, we cannot identify the most appropriate experts to assist in the investigation. As the substance appears to be unknown as of today, we can only suspect UK authorities will employ all of the above during their investigation.

Should this incident turn into a murder investigation, we are likely to see several of the above experts testifying as expert witnesses.

Expert WitnessExpert Witness TestimonyLawyersLitigationMedical

Opioid Crisis – An increase in addiction medicine and pain management expert witnesses.

on November 6, 2017

In the nearly 8 years that I’ve been with Experts.com, I have noticed a massive increase in the number of addiction medicine and pain management expert witnesses marketing their services with our company. Between 2010, when I joined Experts.com, and today, the increase has been nearly five-fold.

Is this increase a surprise? Based on what we’re seeing in the news, the answer is no. The United States is experiencing an opioid epidemic. According to CNN’s Opioid Crisis Fast Facts, “more than two million of Americans have become dependent on or abused prescription pain pills and street drugs.” CNN further explains, “during 2015, there were 52,404 overdose deaths in the United States, including 33,091 (63.1%) that involved an opioid. That’s an average of 91 opioid overdose deaths each day.”

Just last week, I spoke to one expert witness who experienced an opioid-related death in his family.  The same day, hours apart, another expert began promoting his pain management and addiction medicine services on our site. This epidemic is impacting millions of families throughout our country. As a result of this epidemic, and much of the overdoses stemming from prescription medication, we are beginning to see significant litigation in the area of opioid-based pharmaceuticals.

Our Opioid Litigation Experiences:

Experts.com has processed more than a handful of expert witness referrals related to opioids. The cases have ranged from prescription abuse in family law settings to overdose issues resulting in wrongful death actions. Probably the most interesting opioid-related matter was as follows: general counsel for a mining company in a small town discovered the townspeople were using methadone at a rate approximately 5 times higher than the national average. Many citizens of the town were also employees of the mining company. They grew concerned about the potential liabilities of employees operating heavy equipment while ingesting powerful pain killers. The company decided to do some testing which triggered some privacy concerns and potential litigation. We have delivered toxicologists, addiction medicine specialists, and pain management professionals in dozens of different opioid-related cases.

Recent Litigation:

In the last few years, we have seen stories of both civil and criminal litigation related to the opioid epidemic, even before it was claimed to be a crisis. Here are a few of the cases you may want to follow:

Civil Litigation:

There have been many lawsuits against Purdue Pharma (maker of OxyContin) since the early 2000’s. As one article explains, more and more state and local governments are launching lawsuits against the manufacturers and distributors of heavy-duty pain medications. The frequency of these lawsuits is almost weekly.  In addition to Purdue Pharma, Cardinal Health, Teva Pharmaceuticals, Janssen, and others are targeted.

In July of this year, one of the lawyers, Michael Moore, who targeted tobacco companies in the 1990’s, began urging state lawsuits against the drug makers. By August, an Oregon County sued pharmaceutical companies for $250 million for allegedly persuading physicians to over prescribe opioids. As of September, Attorneys General in 37 states were urging insurance companies to do more to curb the opioid epidemic.

What can we deduce from the high-profile coverage of civil suits against the makers of pain killers? In my assessment, the worst is yet to come for the drug makers. This does not mean the drug makers are defenseless against the lawsuits. After all, there are others in the supply chain to be blamed: doctors, pharmacies, and the patients themselves. Over the long-term, the pain medication lawsuits are likely to be very costly for manufacturers and distributors.

Criminal Litigation:

For the sake of brevity, I’m going to ask you to assume that there is significant drug related crime and we’re going to skip the standard (possession and distribution) opioid cases. Where I have noticed a substantial increase, both in the news and in requests for expert witnesses, is in criminal prosecutions of prescribing physicians and pharmacists.

As CNN described, “doctors are increasingly being held accountable — some even facing murder charges — when their patients overdose on opioid painkillers they prescribed.” The article further explains that the DEA took action against 88 doctors in 2011 and 479 doctors in 2016. One of the doctors described has been convicted of murder. I see at least one new story a week where a doctor, or pharmacist, is being held responsible for the excessive amounts of pain killers prescribed.

The numbers described in the article above, combined with a more aware public, lead me to believe we’ll see even larger numbers of DEA actions against doctors when the 2017 statistics are available.

Other Legal Issues:

As you can tell, I focused on the two areas that I’ve noticed the largest increase in visible litigation. We have processed many other expert witness referrals associated with opioid issues. Many overdose cases are resulting in medical malpractice actions as well as actions brought by medical boards for ethical violations by doctors.  We often see the requests for expert witnesses relating to emergency medicine physicians, toxicologists, pharmacy and pharmacology experts, and more.

Opioid litigation may very well be the “tobacco” litigation of our time.  As such, we are confident that we’ll have more to write about and discuss in the future.

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Sports Neurology Expert Witnesses and Concussions

on May 13, 2014

Concussions have been front and center in the news for the last few years. According to the Mayo Clinic, a concussion is “a traumatic brain injury that alters the way the brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. ” Technological advances in Sports Neurology have doctors concerned that such a broad definition does the public a great and very harmful disservice.

photo courtesy of premierelife.ca

Photo Courtesy of Premierelife.ca

In his article, “Plain Talk On Concussions,” Sports Neurologist, Dr. Vernon Williams, explains that the public’s understanding of concussions has been oversimplified for many years.  There are many factors to take into consideration when evaluating a patient. They can include previous brain injury, age, and even gender. Dr. Williams explains that,

“You can’t see a concussion on x-ray, CAT scan, or most MRI’s. But the lack of abnormality on those tests does not mean the brain hasn’t been injured. The injury occurs on a cellular level. When special methods are used, there is evidence of change in how the brain is working that last for days to weeks (evidence of persistent brain dysfunction) even when the injured athlete feels that they are back to 100% and the physical examination is normal.”

Players who engage in high contact sports like football  have a high risk for concussion. The problem has become so pervasive that parents and players have pressured the  NFL and the NCAA to tighten safety standards.  Innovations in helmet safety have come too late for many players. When NFL Hall of Famer, Mike Webster, was diagnosed with a progressive degenerative disease of the brain known as CTE, fellow retirees took note. Before his death, Webster suffered from amnesia, dementia, depression, and chronic pain, all symptoms of CTE.

Since then, approximately 5,000 retired players have filed suit against the NFL alleging the entity hid the dangers of concussions. Among the plaintiffs in these lawsuits are Art Monk, Tony Dorsett, Jim McMahon, Jamal Anderson, and Ray Easterling. Considering how high profile these cases have become, it is no wonder that brain injury has become a growing concern in Sports Medicine litigation.

Concussion litigation in the NFL, sports clubs, and even in school yards across the country have garnered so much attention that George Washington University’s law school has developed a course devoted solely to the legal implications of traumatic brain injuries.  Michael Kaplen, who teaches the course, is a plaintiffs’ lawyer who has worked on cases involving traumatic brain injuries for more than two decades. Kaplen believes the NFL became responsible for the safety of its players when it began studying the cause and effect of concussions over twenty years ago. (See article in The NewYorkTimes.com).

Public safety is the common thread for sports neurologists like Dr. Vernon Williams and litigators like Michael Kaplen.  With advances in medical technology, doctors have learned that the basic warning signs of a concussion which have prevailed for so many years are no longer sufficient. In light of this progress, making the NFL and other organizations accountable for the well-being of its players may be the catalyst to improved neurological health not only for athletes, but for everyone who has suffered traumatic brain injury.

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*Vernon B. Williams, MD specializes in Sports Concussions, Sports Neurology, and Pain Medicine. Dr. Williams is the Founding Director, Center for Sports Neurology and Pain Medicine at the Kerlan-Jobe Orthopedic Clinic in Los Angeles, CA. His clients include the Los Angeles Lakers, Los Angeles Dodgers, Los Angeles Kings, Los Angeles Sparks, among many others.  Dr. Williams’ Profiles on Experts.com.

 

 

 

 

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Should A Medical Society Discipline A Medical Expert Witness For Submitting A “Draft Report?”

on July 16, 2012

Attorneys often retain expert witnesses to consult on a case, to testify at trial or deposition, or to provide a formal written opinion to the court.  Like any other professional engagement, the process usually involves several communications, back and forth, between the attorney and the expert witness, often including preliminary written or oral opinions.

Imagine if you were retained as a medical expert witness,  had written a rough draft, preliminary opinion, and submitted it, mistakes and all, for initial consideration. Then, imagine if this document had been used in court without your knowledge, and the next thing you know, you’re being disciplined based on the quality of the document. 

Something like this actually took place, and the results may have lasting results for those in the medical community. In May, a California jury determined that the American Academy of Orthopedic Surgeons (AAOS) was liable for falsely portraying an orthopedic surgeon after he had acted as an expert witness in a medical negligence case. It seems that the AAOS had suspended the medical expert for allegedly providing improper testimony in the case. Normally, the AAOS would have every legal right to discipline the doctor, but here’s the catch: According to the doctor, the “expert testimony” used in the negligence case was the preliminary report  he had submitted to the plaintiff’s attorney who retained him. It was, therefore, not meant to be used in court. Even worse, according to the doctor, the plaintiff’s attorney had removed the words “draft report” without the doctor’s knowledge. This, in itself, is questionable behavior.  For the AAOS to then suspend the Medical Expert and falsely portray him in its publication is certainly overstepping. This, at least, was the finding of the jury, though of course the AAOS is doing all it can to fight this verdict. It is worth mentioning that the jury verdict awarded damages to the doctor against the law firm as well.

 This is a unique case that could have profound implications, not just for the AAOS but for the medical industry as a whole. If a precedent has been set that expert witnesses can successfully sue medical societies, then this is certain to send shock waves throughout the medical community. Expert witnesses should be permitted to submit preliminary drafts before finalizing the report that will actually be used in court. More importantly, no one—attorney or otherwise—should have the right to alter a draft report and misrepresent it as expert testimony. Furthermore, this case, which is among the first instances of an expert witness successfully challenging a medical society’s disciplinary action in court, may compel these societies to think twice before committing what is essentially libel.

As we might expect, this story is far from over – we could say that it’s still in the “draft report” phase. Judging from what happened to one medical expert, it’s probably wise to keep that draft report in safe keeping….

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PHARMACEUTICAL PRODUCT LIABILITY

on March 8, 2011

With the onslaught of legal drugs on the market, pharmaceutical product liability cases have become mainstream in the court system.  It boggles the mind how many possible harmful side effects there are for one medication alone.  Just listen to any commercial for depression medicine – and you’d better listen carefully.  They have to speak quickly to get them all in.

If a pharmaceutical company lists all possible harmful effects, does that relieve them from liability?  Do a certain number of people have to die or have a stroke in order for the drug to be pulled from the market?  Conversely, did the patient do something to exacerbate the problem?  Take too much of the medicine?  Not enough?  Is the pharmacy liable for miscalculating the dosage?

This is when Pharmaceutical, Pharmacology and Toxicology Experts and Consultants come into play.  The variables are so complex and many that a case cannot be thoroughly adjudicated without the scientific and practical experience that these particular Experts hold.  They use their skills to review medical and pharmacy records, evaluate drug delivery standards of care, toxicity, adverse drug events and even FDA regulations.  These Experts and Consultants are retained to determine the period of time a drug was used and a patient’s average compliance or adherence to taking a drug, among so many other things.

The bottom line is that Pharmaceutical, Pharmacology and Toxicology Experts and Consultants are essential to resolving complex medical issues involving pharmaceuticals and drugs.  That they play a major role in helping to regulate the industry, compensate the injured and defend the innocent cannot be denied.